The document summarizes the current state of health reform in the United States after the Supreme Court ruling upholding the Affordable Care Act. It discusses public opinion polls showing that a majority of Americans oppose the health reform law and believe it will make things worse. It also outlines ongoing resistance movements from governors, citizens, employers, and Congress. The document analyzes impacts on employers from new taxes and penalties as well as effects on employees from rising costs and responsibilities under the reform. It concludes by arguing for market-based, state-led alternatives that enhance choice, value, and focus on the patient rather than government control over healthcare decisions.

1. Health Reform:
A not-for-profit
health and tax policy
research organization Where are we now?
Grace-Marie Turner
January 8, 2013
Central Kentucky Association of Health Underwriters
/GalenInstitute
www.galen.org

11. www.galen.org

12. www.galen.org

13. www.galen.org

14. www.galen.org

15. Source: Ari Melber,”POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,” The Nation, July 4, 2012,
http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.

16. Americans agreed on goals for health reform…
• The U.S. needs health reform to:
– make coverage more affordable
– assure quality, and
– expand access to insurance
• Most people rate their own coverage as
good or excellent
• They want stability. Change is for
others.
www.galen.org

17. Americans’ views of health law
after Supreme Court decision
• Americans say it will make things worse rather
than better for taxpayers, businesses, doctors,
and those who currently have health
insurance.
• Opposition to the law higher after Supreme
Court decision.
Sources: “Americans: Healthcare Law Helps Some, Hurts Others ,” Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-
Helps-Hurts-Others.aspx?utm_source=add%2Bthis&utm_medium=addthis.com&utm_campaign=sharing#.UARkmBS6osE.twitter. The New York Times/CBS
News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. “Kaiser Health Tracking Poll,” The Kaiser Family Foundation, July
2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf

18. Source: “Kaiser Health Tracking Poll: July 2012,” The Henry J. Kaiser Family Foundation, July 31, 2012, http://www.kff.org/kaiserpolls/8339.cfm.

19. Majority of Americans Oppose
Government Health Care
Gallup asked: Do you think it is the responsibility of the federal
government to make sure all Americans have healthcare coverage,
or is that not the responsibility of the federal government?
% Government responsibility % Not government responsibility
69
64 64 64
62 62
59 58
54 54
50 50 50
47 47
46
44
41
39 38
34 35 34 33
31
28
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 2011 2012
Source: Jeffrey M. Jones, “Now Against Gov't Healthcare Guarantee,” Gallup Politics, November 28, 2012,
http://www.gallup.com/poll/158966/majority-against-gov-healthcare-guarantee.aspx.

21. The health law in one graph
Source: Avik Roy, “Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,” Forbes: The Apothecary, August 16, 2012,
http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.

23. Why ObamaCare isn’t settled
 38% of Americans supported the law in the
last major poll before the November elections
 Of the 50.6% who voted for President
Obama…
12% said they wanted the law repealed
The election was not about ObamaCare
Source: “Kaiser Health Tracking Poll: October 2012,” The Henry J. Kaiser Family Foundation, October
31, 2012, http://www.kff.org/kaiserpolls/8381.cfm.

24. ObamaCare Resistance Movement
Governors: No exchanges or Medicaid
expansion
Citizens: Pay fine rather than buy insurance
Employers: Seeking ways to avoid fines
Congress: Delay, defund, dismantle, do strict
oversight
Legal challenges: 40 and counting, including
challenge to religious liberty

25. State Actions to Address Health Insurance Exchanges
Pursuing state-run State plans to State has not Pursuing state-run State not establishing
exchange: enacted partner with federal declared their exchange: executive a state-run exchange
legislation government plan to HHS branch
Source: “State Actions to Address Health Insurance Exchanges,” National Conference of State Legislatures, December
20, 2012, http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx.

26. Exchange bureaucracy
Source: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012,
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/.

28. ObamaCare’s New Taxes
Source: Philip Dittmer and William McBride, “Obamacare's New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.

29. More ObamaCare Taxes
Source: Philip Dittmer and William McBride, “Obamacare's New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.

30. Mercer: Employers planning workforce changes
w Mercer study on what employers expect
Source: “Health Reform Poses Biggest Challenges to Companies with the Most Part-Time and Low-Paid Employees,” Mercer LLC, August
8, 2012, http://www.mercer.com/press-releases/1472805.

31. Employer mandate penalties
For companies with +50 employees
• $2,000 per year per full-time employee for
not providing coverage (minus first 30)
• $3,000 per year for any employee getting
insurance through the Exchanges
* If an employer offers employee-only
coverage that’s “affordable” to the
worker, family members are not eligible for
Exchange subsidies
www.galen.org

32. Some things to think about
1. Employers with <50 FTE EE’s have no
3k/2k penalty
2. But employers offering qualified and
affordable coverage may actually be
hurting their employees
Example
SCOTUS Success
Boot Camp

33. Generous Subsidies in
Examples: Exchanges
• A person earning $42,000 a year with a family
of 4 qualifies for $14,759 in new health
insurance subsidies
• A single person earning $20,600 qualifies for
$5,156 in new health insurance subsidies
But only if employer doesn’t offer coverage or if
it’s not “affordable” (ie costs >9.5% of income)
www.galen.org

34. But employee share still steep
Examples:
• A young family earning $35,000 a year would have
to pay up to $5,555 in total health costs for a
$12,130 Silver plan ($1,388/prem.; $4,167 OOP)
• A slightly older family earning $85,000 would have
to pay up to $16,408 in total health costs for a
$15,116 Silver plan ($8,075/prem.; $8,333 OOP)
Source: Estimates based upon the Kaiser Family Foundation’s Health Reform Subsidy Calculator, http://healthreform.kff.org/subsidycalculator.aspx.
Grace-Marie Turner, “ObamaCare: Pain 2.0,” New York Post, December 27, 2012, http://tinyurl.com/ag92fgv.

35. Some realities:
www.galen.org

36. What we know for sure
• CHOICE: Americans value
innovation, diversity and choice to
accommodate 300 million people
• VALUE IN HEALTH SPENDING: To realize
the promise of personalized medicine and
achieve overall cost saving, break down
payment silos
• FOCUS ON THE PATIENT: They want
doctors and patients, not government, to
make health care decisions

37. Source: Frank Hill, “The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012,
http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.

38. A market-based solution
“Defined contributions” for health coverage
A system that puts doctors and patients in charge of
medical decisions
Restructuring financing for a 21st century health
sector
• Medicare
• Medicaid
• Private Insurance

39. States have a big role
Seek ways improve their markets
• Enhance competition for more choices of
affordable coverage
• Better safety net with functional high-risk
pools
• Private exchanges?
• What suggestions can you present?
www.galen.org

40. Even Europeans going the other way
• Consumerism
• Value of private enterprise
and competition
• Doctor-patient relationship
• Decentralized
decision-making
www.galen.org

41. The future?
• The global move toward
consumerism is real, driven
by greater patient demand
for more control over
decisions.
• People will seek more
affordable options outside
the ACA’s centralized
control.
Search for your opportunities!

42. Why ObamaCare Is Wrong for America
How does the health care law
drive up costs?
Is your doctor really in charge of
your health care decisions?
Are your Constitutional rights
threatened?
Discover the law’s impact on
your life in a new book from
four nationally recognized
health policy experts
Published by Broadside Books,
an imprint of HarperCollins www.WrongForAmericaBook.com
www.galen.org

43. Grace-Marie Turner
A not-for-profit
health and tax policy
research organization
Galen Institute
703-299-8900
gracemarie@galen.org
twitter.com/GalenInstitute
facebook.com/GalenInstitute
Subscribe to our free email alerts at
/GalenInstitute
www.galen.org www.galen.org/subscribe